Updated Apr 2, 2023 - Health

Why over-the-counter Narcan may not reach those most in need

Photo illustration collage of a Narcan package falling out of a plastic shopping bag in front of a background showing a gas station

Photo illustration: Annelise Capossela/Axios. Photos: Scott Olson, Spencer Platt/Getty Images

A life-saving opioid overdose treatment could soon be as common as Tylenol on retail store shelves. The question is whether making it more accessible will get it to the people who need it the most.

Why it matters: Wednesday's FDA approval of Narcan for over-the-counter use has a financial cost. And if insurers or governments don't step up, addiction experts fear it could widen health disparities and undercut the FDA’s goals of addressing a "dire public health need."

The big picture: Health plans generally don't cover over-the-counter medications. And 1 in 5 people with opioid use disorder are uninsured anyhow, meaning they might have to pony up for a two-pack of Narcan that's ranged in price from about $50 to $100 in recent years.

  • Without outreach, people in need may not even know Narcan no longer requires a prescription, said Sarah Scarborough, director of Real Life in Richmond, Virginia, which serves individuals with substance use disorders.

Driving the news: The Centers for Medicare and Medicaid Services, the American Medical Association and some lawmakers are already calling on payers to prioritize making the spray affordable.

  • A Portland, Oregon, nonprofit this week noted that Narcan can cost $90 per dose and that three to four doses may be required to revive a person because the strength of the fentanyl on the streets now, KGW8 reported.
  • Nabarun Dasgupta, a researcher at the University of North Carolina's Injury Prevention Research Center, said he estimates a two-pack of Narcan's nasal spray could go for roughly $40 when it hits the shelves this summer.
  • But the manufacturer, Emergent BioSolutions, hasn't disclosed a list price for the OTC version, though it's vowed to make Narcan accessible.

What they're saying: "If the antidote is four times more expensive than a $10 bag of fentanyl, then the ability for people who actually need naloxone to get it is diminished," Dasgupta told Axios.

  • "What would've made better sense is to have a comprehensive national policy on this that covers the insurance uncertainty," Dasgupta said, similar to how the federal government managed the coverage of rapid tests.
  • States could use their opioid response dollars to subsidize the cost, to ensure those at highest risk can get it, said Sarah Wakeman, Mass General Brigham's medical director for substance use disorder.
  • They are also able to take up legislation to limit Narcan's pricing, similar to how some are working to cap the cost of EpiPens, said John Cawley, a health economist at Cornell University.

Zoom in: There's a likelihood that Narcan's price comes down without the need for a prescription, said Cato Institute senior fellow Jeffrey Singer.

  • "Once it goes over-the-counter, the profit margins are going to drop," Singer told Axios. "It'll get even better when generic over-the-counter becomes available because people can comparison shop."

The bottom line: The reality is there may be people who aren't going to pick it up "unless it's free and easy," said Bonnie Milas, a cardiac anesthesiologist at University of Pennsylvania who has championed widened naloxone access for years.

  • But, Milas told Axios: "Anyone who suffers an overdose should have an equal chance of survival."

Axios health editor Tina Reed contributed to this report.

Go Deeper: Listen to the Axios Today podcast, where host Niala Boodhoo dives into the FDA's approval of Narcan.

Editor's note: This story originally published on March 30.

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